Reno Tahoe Sinus Center Featured in NNBW

Dr. Meier and Reno Tahoe Sinus Center were recently featured in Northern Nevada Business Weekly.

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Award Winning Research

Nicholas Weseley, UNR 2nd year Medical Student, presented his summer research project “A Validated Model for the 22-item Sinonasal Outcome Test Subdomain Structure in Chronic Rhinosinusitis” at the Regional American College of Physicians Meeting on September 27th at the VA Hospital in Reno.  He won first prize for the summer project he headed up in collaboration with Mass Eye and Ear and Harvard Medical School.  He will present again October 13-14th at the Nevada State ACP Meeting in Las Vegas.  Congrats to Nic on his win and all of his hard work!  This research has furthered understanding of quality of life effects in patients with chronic sinusitis.


Josh Meier, M.D. F.A.R.S.

Nevada ENT and Reno Tahoe Sinus Center Collaborate with Harvard Medical School

Dr. Meier recently returned from Chicago where the paper “A Validated Model for the 22-item Sinonasal Outcome Test Subdomain Structure in Chronic Rhinosinusitis” was presented at the American Rhinologic Society’s Annual Meeting.  This paper demonstrated that the 22 questions found in the SNOT-22 can be grouped into 4 subdomains (sleep, nasal, otologic/facial pain and emotional).  Data was provided from 400 patients from Nevada ENT / Reno Tahoe Sinus Center and 400 patients from Harvard / Mass Eye and Ear.  Dr. Meier and Dr. Killeen enjoyed collaborating without colleagues from Boston and look forward to future projects.


What are the symptoms of chronic sinusitis

Chronic sinusitis (CRS) is defined as 12 weeks or more of two or more of the following signs and symptoms:

  • Mucopurulent drainage (anterior or posterior)
  • Nasal obstruction
  • Facial pressure or pain or fullness
  • Decreased smell

In addition, inflammation must be documented by one or more of the following findings:

  • Radiographic imaging showing inflammation in the sinuses
  • Polyps in the nasal cavity
  • Purulent mucus or edema in the middle meatus or anterior ethmoid

Traditionally chronic sinusitis is managed first with saline rinses and a topical nasal steroid. For patients that continue to have a decrement in their quality of life despite medical therapy, then endoscopic sinus surgery can be considered as an option.

Image Guidance in Endoscopic Sinus Surgery

Endoscopic sinus surgery is surgery that is performed using cameras through the nostrils to open up and drain the sinuses. There are no external incisions. Since its inception in the 1980s, it has advanced in leaps and bounds, allowing more extensive surgery with less complications and easier recovery. One of the keys to this advancement has been the use of “image guidance” or computer assisted surgery.

At the beginning of endoscopic sinus surgery, the surgeon will trace the outline of the patients’ face and the computer will align and fuse it with the patient’s sinus CAT scan.   There are two ways that the computer can track where the instruments are during the operation, using magnets or an infrared system. We use the Medtronic Fusion® system at both St. Mary’s and Renown. Once it has been registered, the computer screen will show the surgeon where the tip of the suction or probe is during the operation on the computer screen. This enables the surgeon to confirm his or her location within the sinuses and allow the surgeon to access more complicated structures such as the frontal sinus, the sphenoid sinus and orbital or skull base lesions.

The American Academy of Otolaryngology – Head and Neck Surgery and the American Rhinologic Society endorses the use of image guidance in endoscopic sinus surgery in following situations:

  • Revision sinus surgery.
  • Distorted sinus anatomy of development, postoperative, or traumatic origin.
  • Extensive sino-nasal polyposis.
  • Pathology involving the frontal, posterior ethmoid and sphenoid sinuses.
  • Disease abutting the skull base, orbit, optic nerve or carotid artery.
  • CSF rhinorrhea or conditions where there is a skull base defect.
  • Benign and malignant sino-nasal neoplasms.

Dr. Meier uses this technology commonly, and it enables him to address more disease safely. In the past extensive frontal sinus disease would require an external approach that has increased morbidity, however now with improved visualization, techniques and instrumentation in conjunction with image guidance, Dr. Meier is able to endoscopically treat the majority of frontal sinus disorders without incisions.


Josh Meier, M.D. F.A.R.S.


Update on Chronic Sinusitis

Chronic rhinosinusitis (CRS) is a condition that a large segment of the population suffers from, with a significant decrement in quality of life. Symptoms of CRS include nasal drainage, congestion, facial pain or pressure, and smell loss. Frequently nasal allergies can contribute to symptoms. In Reno, the bulk of allergy symptoms occur in the fall, when the sagebrush and rabbit brush bloom.

The first line of treatment for CRS is a saline rinse (Neilmed sinus rinse) and an over the counter topical steroid spray (Flonase, Nasocort). For most CRS patients, this will lead to a significant increase in quality of life.   For patients that do not improve, then a consultation with an otolaryngologist can be helpful, and other treatment options can be discussed.

An option for patients that continue to have symptoms, despite appropriate medical therapy, is endoscopic sinus surgery (ESS). New technology and techniques have resulted in much less discomfort and recovery after ESS. Because of my focus on mucosal preservation, there is less bleeding; as a result I do not use nasal packing or splints for patients that undergo nasal surgery.

If you have any questions about your nose or sinus health, please do not hesitate to call and schedule an appointment.


Josh Meier, M.D. F.A.R.S.

Nevada ENT

(775) 322 4589